Swaziland Nurse Program Provides Model for AIDS Treatments

TEMBELIHLE, Swaziland — When sores began to appear on the head of Miriam Dlamini, a 38-year-old widow with five children from Christ the King Parish in Swaziland, a trained parish nurse, Sybil Khumalo, went to visit her. The parish nurse encouraged the sick woman to visit the hospital for testing. Dlamini followed her suggestion and discovered she was HIV-positive.

When family members and others in the village found out Dlamini had AIDS, rather than giving her comfort, they avoided her. Her brother-in-law refused to take her to the hospital in his car. She was considered “unclean.” The only person willing to care for her was the parish nurse.

Dlamini died in a hospital shortly after being diagnosed, leaving her children to fend for themselves. When Khumalo checked up on the children, she found them alone, surviving on cooked pumpkin porridge. She fed the children for many days and, after that, ensured they were properly cared for.

Khumalo, and other parish nurses like her who care for AIDS and HIV patients, is part of a program that includes 22 parishes across the nation of Swaziland in a first-ever parish nurse program called “A New Robe.” The innovative program, initiated by a Montana-based organization called Maternal Life International, which works in conjunction with the Catholic Church in Swaziland and Bristol-Myers Squibb, gives concrete expression to the Catholic model for treating AIDS and HIV patients.

Everything about the program, even its name, alludes to Christian ideals.

“The New Robe alludes to the hemorrhaging woman who touched Jesus and was healed, and to the man by the side of the road,” said Dr. George Mulcaire Jones, medical director for Maternal Life International and the one who conceived the structure of this program. “The New Robe is a metaphor for a new way of thinking about AIDS prevention and care. We not only teach our nurses how to protect themselves and how to move a patient with bedsores, but we also teach them about the infinite value of the human person. We ask that they see an AIDS patient with eyes of mercy before eyes of judgment, because a real issue in Africa is stigmatization. So many people think that AIDS patients are unclean.”

In fact, the program received $273,000 from the Bristol-Myers Squibb “Secure the Future” program because of its unique approach.

“The program was approved by the advisory boards because it offers a novel approach for home-based care using parishes as a centerpiece for community support and destigmatization,” said John Damonti, director of the Secure the Future Foundation. “It's a strong de-stigmatization program. We wanted to test that model to see if other communities could use this.”

The program, taking place in a country of approximately 1 million, where the HIV-positive rate is between 30% and 40%, has gained the Church's recognition as well.

Cardinal Alfonso López Trujillo, president of the Pontifical Academy Council for the Family, after learning about the program wrote, “Once it will start spreading it will bring a lot of good with the help of Our Lord.”

The program uses native Swazi nurses trained to combine faith and ministry, medical science and spirituality. Thandi Dlamini, a Catholic Swazi woman and former director of Swaziland Red Cross, runs the New Robe program.

Since the program's inception on Jan. 10, 2001, approximately 1,900 AIDS patients have been treated, 7,200 patients have been counseled and 6,500 education sessions have been provided to parish groups and schools. Parish nurses follow a program model called “the five S's.” When a parish nurse cares for a patient she looks at five categories: specific care, supportive care, symptomatic care, social care and spiritual care. The program strongly believes that no one should die unknown, unloved or alone.

“If you can imagine a parish nurse going to a rural homestead in Swaziland, she might take a bus or a lorry, she might have to walk up to 10 kilometers, and she has a medicine bag with her,” Jones explained about how the five categories come into play. “In that bag are antibiotics to treat infections. She has pain medicine for pain, she has diarrhea medicine. She also has rosaries and prayer cards for Catholic patients. She may bring with her a priest or a catechist, or a deacon to administer the sacrament of the sick. She's bringing all of the five S's with her.”

Another aspect of the program is that it promotes an educational behavior-change program, one that supports abstinence, not condoms.

“The reality of condoms is they don't work,” Jones said. “They are not well-received in the culture. Our program teaches them about the HIV virus and provides them with something that we call the ‘secret.’ The secret is what it means to know, to act and to love.

“We symbolize this by three inter-locking gold rings. We teach them about the HIV virus. We teach them how it is transmitted. Once they know, they act. We teach them about abstinence before marriage and faithfulness within marriage. And then finally they have to know what it means to live in the time of HIV [and] AIDS,” Jones said. “Love is greater than sex. We give them a language for behavioral change and we call it the ‘secret.’”

Jones insisted abstinence works. He pointed to a recent study done by Dr. Rand Stoneburner and Daniel Low-Beer of Cambridge University, partially funded by U.S. Agency for International Development, which found that a decline in AIDS prevalence in Uganda was related more to reduction in sex partners than condom use.

“The data is new, the Uganda study that Rand has done is so interesting,” said Dr. Ann Peterson, assistant administrator for the USAID's Bureau for Global Health — which promotes a mix of abstinence, education and condom use — on Stoneburner's study. “It shows that reducing the number of partners, especially in the young girls, was really instrumental in beginning the decline in Uganda. There is a new message emerging. In the U.S. there were misconceptions that youth couldn't and would-n't abstain. We are seeing in the U.S. and internationally that they can and they will abstain, and it does make a difference for HIV rates.”

Although Catholic models for the New Robe program have been established in Butte, Mont., where Maternal Life International is based, the program is primarily intended to empower in-country people to do the work.

Parish nurses, centered in the village community parish, help HIV-positive parish members in practical matters as well.

“In Swaziland, each family is allotted a homestead. If the family ceases to exist because of AIDS, they lose their homestead,” said John Jones, director of Maternal Life International. “What the nurses are trying to do is to develop a community-based solution where children whose parents have died from AIDS can remain in their homes. This allows them to hold onto their family's land, and it is key to their future. The parish nurses do everything possible to ensure that the orphans can continue to live in the community.”

The entire program is infused with Catholic ideals and spirituality. Dr. George Jones aptly sums it up: “An inspiration for our work is [the encyclical] Evangelium Vitae, the Gospel of Life. An African villager may never have the opportunity to pull Evangelium Vitae off the shelf and read it, but we want them to be able to know of their own infinite value, the estimable dignity of the human being from the way they are treated and cared for.”

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